Daily low-dose aspirin found to have no effect on healthy life span in older people

September 16, 2018, National Institutes of Health
Credit: CC0 Public Domain

In a large clinical trial to determine the risks and benefits of daily low-dose aspirin in healthy older adults without previous cardiovascular events, aspirin did not prolong healthy, independent living (life free of dementia or persistent physical disability). Risk of dying from a range of causes, including cancer and heart disease, varied and will require further analysis and additional follow-up of study participants. These initial findings from the ASPirin in Reducing Events in the Elderly (ASPREE) trial, partially supported by the National Institutes of Health, were published online on September 16, 2018 in three papers in The New England Journal of Medicine.

ASPREE is an international, randomized, double-blind, placebo-controlled trial that enrolled 19,114 older people (16,703 in Australia and 2,411 in the United States). The study began in 2010 and enrolled participants aged 70 and older; 65 was the minimum age of entry for African-American and Hispanic individuals in the United States because of their higher risk for dementia and cardiovascular disease. At study enrollment, ASPREE participants could not have dementia or a and had to be free of medical conditions requiring aspirin use. They were followed for an average of 4.7 years to determine outcomes.

"Clinical guidelines note the benefits of aspirin for preventing heart attacks and strokes in persons with vascular conditions such as coronary artery disease," said NIA Director Richard J. Hodes, M.D. "The concern has been uncertainty about whether aspirin is beneficial for otherwise healthy older people without those conditions. This study shows why it is so important to conduct this type of research, so that we can gain a fuller picture of aspirin's benefits and risks among healthy older persons."

The team of scientists was led by John J. McNeil, M.B.B.S., Ph.D., head of the Department of Epidemiology and Preventive Health at Monash University, Melbourne, Australia, and Anne M. Murray, M.D., director of the Berman Center for Outcomes and Clinical Research at Hennepin Healthcare in Minneapolis. The research was supported in part by the National Institute on Aging (NIA) and the National Cancer Institute (NCI), both parts of the NIH. The Australian component of the study also received funding from the Australian National Health and Medical Research Council and Monash University. Aspirin and placebo were supplied by Bayer, which had no other involvement with the study.

In the total study population, treatment with 100 mg of per day did not affect survival free of dementia or disability. Among the people randomly assigned to take aspirin, 90.3 percent remained alive at the end of the treatment without persistent physical disability or dementia, compared with 90.5 percent of those taking a placebo. Rates of physical disability were similar, and rates of dementia were almost identical in both groups.

The group taking aspirin had an increased risk of death compared to the : 5.9 percent of participants taking aspirin and 5.2 percent taking placebo died during the study. This effect of aspirin has not been noted in previous studies; and caution is needed in interpreting this finding. The higher death rate in the aspirin-treated group was due primarily to a higher rate of cancer deaths. A small increase in new cancer cases was reported in the group taking aspirin but the difference could have been due to chance.

The researchers also analyzed the ASPREE results to determine whether took place. They found that the rates for major cardiovascular events—including coronary , nonfatal heart attacks, and fatal and nonfatal ischemic stroke—were similar in the aspirin and the placebo groups. In the aspirin group, 448 people experienced cardiovascular events, compared with 474 people in the placebo group.

Significant bleeding—a known risk of regular aspirin use—was also measured. The investigators noted that aspirin was associated with a significantly increased risk of bleeding, primarily in the gastrointestinal tract and brain. Clinically significant bleeding—hemorrhagic stroke, bleeding in the brain, gastrointestinal hemorrhages or hemorrhages at other sites that required transfusion or hospitalization—occurred in 361 people (3.8 percent) on aspirin and in 265 (2.7 percent) taking the placebo.

As would be expected in an older adult population, cancer was a common cause of death, and 50 percent of the people who died in the trial had some type of cancer. Heart disease and stroke accounted for 19 percent of the deaths and major bleeding for 5 percent.

"The increase in cancer deaths in in the aspirin group was surprising, given prior studies suggesting aspirin use improved cancer outcomes," said Leslie Ford, M.D., associate director for clinical research, NCI Division of Cancer Prevention. "Analysis of all the cancer-related data from the trial is under way and until we have additional data, these findings should be interpreted with caution."

"Continuing follow-up of the ASPREE participants is crucial, particularly since longer term effects on risks for outcomes such as cancer and dementia may differ from those during the study to date," said Evan Hadley, M.D., director of NIA's Division of Geriatrics and Clinical Gerontology. "These initial findings will help to clarify the role of aspirin in disease prevention for older adults, but much more needs to be learned. The ASPREE team is continuing to analyze the results of this study and has implemented plans for monitoring participants."

As these efforts continue, Hadley emphasized that older adults should follow the advice from their own physicians about daily aspirin use. It is important to note that the new findings do not apply to people with a proven indication for aspirin such as stroke, heart attack or other cardiovascular disease. In addition, the study did not address aspirin's effects in people younger than age 65. Also, since only 11 percent of participants had regularly taken low-dose aspirin prior to entering the study, the implications of ASPREE's findings need further investigation to determine whether healthy older people who have been regularly using for disease prevention should continue or discontinue use.

Explore further: ARRIVE trial of daily aspirin does not show lower risk of first cardiovascular event

More information: Abstract/Full Text 1
Abstract/Full Text 2
Abstract/Full Text 3

Related Stories

ARRIVE trial of daily aspirin does not show lower risk of first cardiovascular event

August 27, 2018
The role of aspirin in preventing a first heart attack or stroke among people at moderate risk of heart disease remains unclear. At the 2018 European Society of Cardiology meeting, J. Michael Gaziano, MD, a preventive cardiologist ...

Aspirin use doesn't cut cancer incidence in older T2DM patients

June 25, 2018
(HealthDay)—For Japanese patients with type 2 diabetes, low-dose aspirin is not associated with reduced cancer incidence, except in those younger than 65 years, according to a study published online June 16 in Diabetes ...

Jury still out on aspirin a day to prevent heart attack and stroke

August 26, 2018
The jury is still out on whether people at moderate risk of a first heart attack or stroke should take daily aspirin to lower their risk, according to late breaking results from the ARRIVE study presented today in a Hot Line ...

Bleeding in patients treated with anticoagulants should stimulate search for cancer

August 26, 2018
Bleeding in patients treated with anticoagulants should stimulate a search for cancer, according to late breaking results from the COMPASS trial presented today at ESC Congress 2018.

World-first aspirin study reaches new milestone

December 2, 2014
Australia's largest clinical trial is a step closer to revealing in 2018 whether healthy older people should or should not take aspirin to prevent or delay cardiovascular disease (heart attack and stroke), dementia, depression ...

Quitting daily aspirin therapy may increase second heart attack, stroke risk

September 25, 2017
Stopping long-term, low-dose aspirin therapy may increase your risk of suffering a cardiovascular event, according to new research in the American Heart Association's journal Circulation.

Recommended for you

Aspirin could play valuable role as additional treatment for cancer

September 26, 2018
Regular use of aspirin could help in the treatment of some cancers, finds a new review of 71 medical studies.

Height may be risk factor for varicose veins, study finds

September 24, 2018
The taller you are, the more likely you are to develop varicose veins, according to a study led by Stanford University School of Medicine researchers that examined the genes of more than 400,000 people in search of clues ...

Physical activity necessary to maintain heart-healthy lifestyle

September 24, 2018
Exercise and physical activity are of vast global importance to prevent and control the increasing problem of heart disease and stroke, according to a review paper published today in the Journal of the American College of ...

Prosthetic valve mismatches common in transcatheter valve replacement, ups risk of death

September 24, 2018
In the largest multi-institutional study to date, led by researchers from Penn Medicine, the team found that among patients who underwent a transcatheter aortic valve replacement (TAVR), a high number experienced severe and ...

Study reveals a promising alternative to corticosteroids in acute renal failure treatment

September 21, 2018
A protein produced by the human body appears to be a promising new drug candidate to treat conditions that lead to acute renal failure. This is shown by a study conducted at São Paulo State University (UNESP) in São José ...

Can a common heart condition cause sudden death?

September 20, 2018
About one person out of 500 has a heart condition known as hypertrophic cardiomyopathy (HCM). This condition causes thickening of the heart muscle and results in defects in the heart's electrical system. Under conditions ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.